Search

Objectives: This study describes an unsupervised machine learning approach used to estimate the homeostatic model assessment-insulin resistance (HOMA-IR) cut-off for identifying subjects at risk of IR in a given ethnic group based on the clinical data of a representative sample. Methods: The approach was applied to analyse the clinical data of individuals with Arab ancestors, which was obtained from a family study conducted in Nizwa, Oman, between January 2000 and December 2004. First, HOMA-IR-correlated variables were identified to which a clustering algorithm was applied. Two clusters having the smallest overlap in their HOMA-IR values were retrieved. These clusters represented the samples of two populations, which are insulin-sensitive subjects and individuals at risk of IR. The cut-off value was estimated from intersections of the Gaussian functions, thereby modelling the HOMA-IR distributions of these populations. Results: A HOMA-IR cut-off value of 1.62 ± 0.06 was identified. The validity of this cut-off was demonstrated by showing the following: 1) that the clinical characteristics of the identified groups matched the published research findings regarding IR; 2) that a strong relationship exists between the segmentations resulting from the proposed cut-off and those resulting from the two-hour glucose cut-off recommended by the World Health Organization for detecting prediabetes. Finally, the method was also able to identify the cut-off values for similar problems (e.g. fasting sugar cut-off for prediabetes). Conclusion: The proposed method defines a HOMA-IR cut-off value for detecting individuals at risk of IR. Such methods can identify high-risk individuals at an early stage, which may prevent or delay the onset of chronic diseases such as type 2 diabetes. Keywords: Unsupervised Machine Learning; Cluster Analysis; Insulin Resistance; Diabetes Mellitus, Type II.

Objectives: Emergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman. Methods: This retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care. Results: The proportion of emergency cases was

Objectives: This study aims to describe healthcare professionals' experience in providing mental health services to women with postpartum depression. Methods: In this qualitative study, data were collected through semi-structured interviews with five physicians, five midwives, and five psychologists from fourteen urban healthcare centers in Kerman, Iran, from April 2019 to September 2019. We used purposeful sampling to select the participants. Data were qualitatively analyzed using a content analysis approach. Results: Data analysis revealed the main theme of the study, "the long way ahead of comprehensive, integrated and responsive mental health services." This theme includes four categories: "postpartum depression challenges, "social and personal factors," "structural challenges," and "need to change in the mental health services." The participants described that the diagnosis of depression is difficult due to insufficient knowledge of healthcare providers and hidden signs of postpartum depression. The participants described how different factors might cause depression. These factors were economic, cultural factors in the society, personality traits, community lack of knowledge, negative attitude toward depression, and limited family support. Moreover, providing mental health services has some challenges, such as limited human resources, insufficient financial resources, and incomplete or inefficient policy makings. Conclusion: Although measures have been taken to provide mental health services, there are many challenges regarding providing mental health services to mothers. Therefore, there is a need to take serious measures to improve mental health services and re-define the existing measures. Informing the community, empowering the healthcare providers, and planning to change the community's attitude and belief can affect women's mental health care with depression. Keywords: Postpartum Depression, Mental Health Services, Community Mental Health Services, Mental Disorders, Depressive Disorder.

Objectives: Vaccination is the provision of a vaccine to initiate immunity trough stimulating immune system to develop protection from a certain disease. When a sufficiently large proportion of a population has been vaccinated, herd immunity initiated. The effectiveness of vaccination has been widely studied and verified. Although the harsh vaccine safety systems, some parents remain minded regarding the safety of the childhood vaccines and immunization schedule. These hesitations pushed some parents to not allow their children to receive some or all the scheduled vaccines. The aim of the study is to assess the general population awareness regarding vaccines and to detect prevalence of vaccine hesitancy in Aseer region, southern of Saudi Arabia. Methods: A descriptive cross-sectional approach was used targeting all parents in Aseer region. Data were collected using structured questionnaire which developed by the researchers after intensive literature review and expert’s consultation. The questionnaire data included parents’ socio-demographic data, parents’ awareness regarding child vaccines safety and efficacy, parents’ attitude and adherence to children vaccination and hesitancy towards vaccines. Results: The survey included 796 participants whose ages ranged from 18 to 55 years old. Two thirds (63.4%) of the participants were females. Regarding vaccination adherence and hesitancy among participants, more than three quarters were completely adherent to the child vaccination schedule and only 3.9% were non adherent. As for participants awareness regarding child vaccination safety and efficacy, 89.3% of the respondents agreed on that vaccination keep child healthy, 84.2% reported that child vaccine is safe and effective, 83.4% said that all Saudi scheduled vaccines are effective. Conclusion: In conclusion, the study revealed that vaccine hesitancy among participants was not low and should be considered irrespective of their high awareness level. The recorded antivaccine action was mostly related to vaccines safety not efficacy. Keywords: Vaccine hesitancy, antivaccine movement, parents, awareness, adherence

Objective: Cervical cancer is the third most common type of cancer among women in Oman. Although it can be detected early in the premalignant stages, there is as yet no national program for cervical cancer screening. This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women. Methods: A cross-sectional study was conducted from March to December 2019 at the gynecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21–65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a selfreported sheet. Pap smears were performed and the results reported by a cytotechnologist and histopathologist. Results: A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( p = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity ( p >0.050 each). Conclusions: The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. Moreover, the findings of this study highlight the need for a future vaccination program against HPV infections. Keywords: Cervical Cancer; Screening; Cytological Abnormalities; Pap Smear; Human Papillomavirus; Oman.

Objectives: Herbal treatments are commonly used by Saudi women during pregnancy. However, the inappropriate use of some herbs can have side-effects for both the mother and the fetus. Thus, a comprehensive understanding of their use during pregnancy is crucial. This study aimed to explore the use of herbal treatments by Saudi women during pregnancy using the knowledge-attitude-practice model. Methods: This cross-sectional study was conducted from September 2019 and April 2020 in Riyadh, Saudi Arabia, on a convenience sample using an online Arabic-language questionnaire. Saudi women aged between 18–58 years who were pregnant or had been pregnant and were living in the Riyadh were included. Results: A total of 400 individuals participated in this study. All participants lacked knowledge about the side-effects of herbal treatment but 63% knew about unsafe herbs in general. Most participants (66%) had a neutral attitude towards herbal treatments. Almost half of the participants (48%) did not use herbs during pregnancy and a similar number (47%) sometimes used herbal treatments during pregnancy. There was a significant positive correlation between attitude and practice and a negative correlation between knowledge and attitude as well as between knowledge and practice (P

Objectives This study aimed to assess the knowledge, attitudes and practices (KAPs) of primary care physicians (PCPs) regarding tobacco dependence treatment (TDT) and to identify barriers to TDT practice in Muscat, Oman. Methods This cross-sectional study was carried out from September 2019 to December 2019 at all 27 health centres in Muscat. All 313 PCPs working in these health centres were invited to participate. An adapted version of a previously validated 36-item questionnaire was used to assess KAPs regarding TDT services. Results A total of 255 PCPs completed the survey (response rate: 81.5%) and they demonstrated poor knowledge (40%) but positive attitudes (60%) about TDT services. Of these, the majority were female (85.9%), had never smoked (99.2%) and were general practitioners (64.3%). The mean age was 34.3 ± 6.3 years. Only 28.2% had previously received TDT training and less than half displayed accurate TDT-related knowledge, with undergraduate medical school representing the main source of such knowledge (58.8%). While 96.9% of the PCPs agreed on the importance of TDT, only 28.6% reported feeling sufficiently confident to provide such services themselves. Lack of training (83.5%) and time (71.4%) were the main barriers to TDT practice. Conclusion Overall, PCPs in Muscat demonstrated poor knowledge but positive attitudes with regard to TDT; however, further knowledge and training is required in order to ensure the effective and accurate provision of TDT services. These findings provide baseline data which may be of value for further research and in overcoming barriers to TDT practice in Oman; for instance, establishing cessation services as part of the package of care in primary health centres could address the time constraints barriers identified by the PCPs.

Objectives: Assault induced trauma (AIT) is a public health concern that must be addressed and acknowledged. To our knowledge, in Oman, this issue has not been studied before. This study aims to characterize cases of AIT presenting to Sultan Qaboos University Hospital (SQUH). Methods: This is a retrospective descriptive study of patients presenting with AIT to the emergency department of SQUH fromthe 1 January 2007 to the 31 of December 2018. Data obtained included incidence, patients’ demographics, mode of assault, triaging, management and hospital stay. The data were collected using the Hospital Information System “TrakCare” and analyzed using Statistical Package for the Social Sciences (SPSS). Results: The total cases of AIT identified were 268 cases and 239 fulfilled the study criteria. The highest incidence recorded was in 2018 accounting for 72 cases. The sample was predominantly composed of males at 81%, and 58% of the total cases were Omani citizens. In addition, 66% of the total sample were between the age of 20 and 39. The most common mode of assault implicated was the use ofbodily force (35%).Additionally, 18% were triaged as red cases. In terms of management, 84% of the cohort were treated non-surgically. No incidence of in-patient mortality was recorded. Conclusion: This is the first study that looked into AIT in Oman. Results of this study will aid in providing basis for future research and estimation of the magnitude of this problem in the community. Keywords: cervical smears, conventional slides, ThinPrep slides, cervical organisms.

Objectives: This study aimed to examine the effects of an individual’s generation group on anxiety related to online learning among students and online learning and teaching activities among faculty. Methods: This cross-sectional study was conducted at the University of Sharjah, Sharjah, United Arab Emirates, in April 2020 using the Online Course Anxiety Scale. The questionnaires were sent to 370 undergraduate students and 81 faculty members via email and the responses were stratified by generation. Descriptive statistics and an independent sample t-test was used to compare the mean scores of online learning anxiety with gender and previous experience among faculty and students. Results: A total of 358 students and 70 faculty members completed the questionnaire (response rate: 96.8% and 86.4%, respectively). Only 5.7% of the faculty (compared to 54.7% of the students) enjoyed browsing internet resources during online learning. Among the faculty, 75.7% experienced anxiety during online teaching compared to 37.7% of students. Of the faculty, 92.3% of baby boomers felt anxious compared to 70.5% and 76.9% of X and Y generations, respectively. Conclusion: While students of Generations Z and Y enjoyed browsing the internet during online learning, the Generation Z students were anxious during online discussions and concerned about the misinterpretation of their written communication. Anxiety among faculty members was related to confusion regarding the use of the internet and computers and misinterpretations of text-based messages. Keywords: Anxiety; Online Learning; Generations; Work Engagement; Medical Education; United Arab Emirates.

Objectives A limited number of publications from the Middle East have focused on neuroblastoma, a common childhood malignancy. This study describes the clinical characteristics and survival outcome of Omani children with neuroblastoma treated at the National Oncology Centre, Oman, between 2010 and 2017. Methods From January 2010 to December 2017, data on Omani children aged less than 13 years with neuroblastoma were retrospectively collected. Survival data were statistically correlated with known prognostic factors, including age, stage of disease, MYCN profile and presence of metastasis. Results A total of 56 Omani children were included. in this study. The male to female ratio was 1:1. The mean age at presentation was one year and 10 months. The two most common presenting complaints were body masses (48.2%) and constitutional symptoms (33.9%). Approximately, 54.5% were high risk, 35.7% were intermediate risk and 9.8% were low risk. High-risk neuroblastoma was mainly found in children older than one year (76.6%), with low risk mainly observed in children less than one year of age (80%). The overall survival of all groups combined was 74% (P

Objectives Infectious diseases are the most common cause of disease stigmatisation, which can lead to a denial of healthcare, education, housing and employment as well as physical violence. Such stigmatisation is common during pandemics. This study aimed to examine the social stigmatisation of COVID-19 among residents of Riyadh, Saudi Arabia. Methods A cross-sectional descriptive study was conducted in Riyadh in May 2020. Non-probability convenient sampling was used to recruit 847 participants through social media platforms, including WhatsApp. The data were analysed using descriptive statistics, the Pearson correlation coefficient and the chi-squared test were used along with a multiple linear regression model. Results There was a high level of stigma among 21% of the participants and an intermediate level in almost 49% of the participants. Low stigma was indicated among 30% of the study’s sample. A highly significant association existed between stigma, on the one hand, and older age groups, being married and lower levels of education, on the other. Conclusion Future awareness programmes should educate patients and their families about stigma as well as the consequences of stigmatising COVID-19. Stigma eradication policies and interventions should be implemented to avoid potentially harmful consequences for public health.

Objectives Whole-slide imaging and virtual microscopy (VM) have revolutionised teaching, diagnosis and research in histopathology. This study aimed to establish the feasibility of achieving early integration of clinical reasoning with undergraduate pathology teaching on a VM platform and to determine its student-centricity through student feedback. Methods This study was conducted at the Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates, between August and December 2017. A total of 38 VM-centred clinical cases were introduced to 49 students in an integrated undergraduate medical curriculum. The cases were aligned to curricular objectives, reinforced the pathologic basis of disease with critical thinking and were delivered across 15 interactive small-group sessions. A simulated cross-disciplinary integration and judicious choice of pertinent diagnostic investigations were linked to principles of management. Feedback was obtained through a mixed-methods approach. Results User-friendliness, gradual learning curve of VM and annotation-capacity were scored as 4-5 (on a Likert scale of 1-5) by 91.84%, 87.76% and 83.67% of the participants, respectively. Most students agreed that the content matched the stage of learning (81.63%), theme of the week (91.84%) and development of a strong clinical foundation (77.55%). Integration (85.71%) and clinico-pathological correlation (83.67%) were the strengths of this educational effort. High student attendance (~100%) and improved assessment scores on critical thinking (80%) were observed. Software lacunae included frequent logouts and lack of note-taking tools. Easy access was a significant student-centric advantage. Conclusion A VM-centred approach with a clinico-pathological correlation has been successfully introduced to inculcate integrated learning. Using the pathologic basis of disease as a fulcrum and critical reasoning as an anchor, a digitally-enabled generation of medical students have embraced this educational tool for tutor-guided, student-centred learning.

Objectives: The study aims to evaluate the barriers and perception towards spectacle wear among student population of University of Buraimi, Oman. Methods: This descriptive, questionnaire based, cross-sectional study was conducted between December 2017 and May 2018. To evaluate participant’s barriers and perception towards spectacle wear, a self-designed, validated questionnaire prepared in English language, obtained responses from 170 a university student population within the Sultanate of Oman. Chi-square test was used to assess the association between the type of perception with the socio-demographic and refractive error related profiles of the participants. Results: All participants with inappropriate spectacle correction (61.82%) responded to the questionnaire. Majority of them (73.5%, n = 125) were having their eyes examined for the first time. Only 28 (16.5%) were wearing spectacles. Nearly half of the participants (54%, n = 91) had positive attitude towards spectacle wear, followed by negative (36%, n = 62) and neutral perception (10%, n = 17). Participants from a health science background had a higher positive perception towards spectacle wear compared to the non-medical study majors (P = 0.012). The difference in the perception scores between myopic and hypermetropic refractive error group was statistically insignificant (P = 0.882). Conclusion: A majority of the participants were having inappropriate spectacle corrections and did not undergo any prior ocular examinations. Very few participants were wearing spectacles, however, it was inappropriate concerning their current refractive status. The other reasons for spectacle non-wear were, ordering of new spectacles, lost them, or were broken. Nearly half of the participants had positive perceptions towards spectacle wear. The positive perception was higher among students with health-related majors. The study stresses to extend the current school eye health initiative within the region to the university level. A holistic eye health promotional approach integrating students, teachers, and parents can help in improving spectacle wear within the population. Keywords: Eyeglasses; Refractive errors; School eye health; Spectacle compliance; Patient compliance.

Objectives: This study aimed to estimate the prevalence of social media usage and Internet addiction among Oman Medical Specialty Board (OMSB) residents and to determine associations between Internet addiction and sociodemographic characteristics and symptoms of depression. Methods: This cross-sectional study took place between January and March 2017. All 499 residents enrolled in OMSB training programmes during the 2016–2017 academic year were targeted. A self-administered questionnaire was distributed to collect information concerning sociodemographic characteristics. In addition, the Patient Health Questionnaire-9 and Internet Addiction Test were used to screen for depression and Internet addiction, respectively. Results: A total of 399 residents participated in the study (response rate: 80%). Overall, 115 residents (28.8%) had varying degrees of depression and 149 (37.3%) were addicted to the Internet; moreover, among those addicted, 54 (36.2%) had depression. While no significant associations were observed between Internet addiction and sociodemographic characteristics, the association between Internet addiction and depression was statistically significant (P = 0.004). Conclusion: Internet addiction was clearly detected among OMSB residents, with a significant association observed between Internet addiction and depression. Although a causal link between these two variables cannot be established as depression is multifactorial in origin, the disadvantages and harmful effects of excessive Internet and social media usage need to be addressed. Further research on the consequences of Internet addiction and its effect on quality of life and academic achievement is recommended. Keywords: Internet; Social Media; Social Networking; Addictive Behaviors; Depression; Medical Students; Oman.

Objectives: This study aimed to explore the intelligence quotient (IQ) profile among children with autism spectrum disorder (ASD) and identify the most important subscales that predict the IQ. The analysis of an intellectual profile with age and gender differentials and the identification of a battery of subscales of intelligence are important for clinical management of ASD among children and for facilitating placement for remedial and educational services. Methods: Data were collected through an exploratory study of 100 children aged between three and 13 years, who were referred to the department of child health and development in Sultan Qaboos University Hospital, a tertiary hospital, in Oman between June 2016 and June 2019. Results: Among the 100 participants of this study, 79% were male, resulting in a male–female ratio of 4:1. The mean of full-scale IQ was found to be 68.6 } 18.1. Furthermore, the mean of nonverbal IQ (73.5 } 17.5) was significantly higher than that of verbal IQ (65.5 } 17.6). Finally, more than half (61%) of the children were observed to have had mild to moderate impairment in their IQ levels. Conclusions: Age and gender showed no significant association with IQ level. The regression analysis identified nonverbal fluid reasoning, nonverbal visual-spatial processing, nonverbal working memory and verbal knowledge as the significant predictors of total IQ. The crucial dimensions of verbal and nonverbal IQ identified in this study can be used to evaluate complicated cases. Keywords: Autism; Intelligence; Oman.

Objectives A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed. Methods This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival. Results A total of 50 infants and children were included in this study. The in-hospital mortality and interstage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR] = 3.00, 95% confidence interval [CI]: 1.98–4.76; P = 0.007) and cardiopulmonary bypass (OR = 4.09, 95% CI: 2.44–6.85; P = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0–34.0 months). Conclusion The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality.

Objectives: Professionalism has garnered immense attention in medical education due to increased societal accountability and focus on excellence in healthcare. However, less attention has been given to identifying attitudes about professionalism in medical students who are the future advocates of the healthcare system. This study aimed to assess perceptions of Saudi undergraduate medical students towards professionalism. Methods: A crosssectional survey was carried out among second and sixth year students of the College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, in September 2018. A self-administered professionalism questionnaire was anonymously completed. Students were asked to provide their level of agreement with 18 survey items using a 5-point Likert scale. Results: Overall, 288 students participated in the study (males: 49.3% and females: 50.7%), with a response rate of 90%. The median professionalism score was high (71.0; range: 64–76) regardless of age, gender or level of education. Similar high scores were noted in the following subscales: Excellence, 20.0 (range: 18–21); Respect for Others, 17.0 (14–18); Altruism, 12.0 (10–13); Duty, 8.0 (7–9); Accountability, 7.0 (6–8) and Honour and Integrity, 8.0 (7–10). No gender differences were observed in the majority of subscales. However, males demonstrated higher scores in the Duty subscale (males: 9.0 versus females: 8.0; P = 0.026). Conclusion: Medical students demonstrated high professionalism scores. Future studies are needed to assess the impact of the course curriculum on their level of professionalism over time. Keywords: Attitudes; Curriculum; Medical Students; Professionalism; Survey; Saudi Arabia.

Objectives: Burnout syndrome is a condition that is well-documented globally among medical students and affects their academic performance due to high levels of associated stress and psychiatric morbidities. This study aimed to assess burnout prevalence and predictors along with its association with academic performance among medical students at Hail University, Saudi Arabia. Methods: A questionnaire-based cross-sectional survey of medical students was conducted between May and June 2019 at the Medical College at Hail University. The English version of the Maslach Burnout Inventory (MBI)-Student Survey was used to assess the three components of burnout syndrome— cynicism, emotional exhaustion and professional efficacy. A fixed-model multivariate logistic regression analysis was conducted for each of the three MBI components’ levels and for total burnout to identify factors significantly associated with burnout syndrome. Results: A total of 218 students were included in this study (response rate: 53.8%). The majority of participants were female (n = 121; 55.5%) medical students ranging between 21–24 years of age. High emotional exhaustion, high cynicism and low professional efficacy was found among 79.4%, 61.0%, and 37.6%, respectively, of respondents. The overall prevalence of high burnout was 27.1% (n = 59). Female students were at almost double the risk for high emotional exhaustion compared to male students (adjusted odds ratio [AOR] = 2.14, 95% confidence interval [CI]: 1.06–4.34; P = 0.034). Students with grade point averages (GPA; on a four-point scale) ranging between 3.51–4.0 were considerably less prone (83% less risk) to experience burnout as compared to students with a GPA ≤2.0 (AOR = 0.17, 95% CI = 0.03–0.91, P = 0.039). Conclusion: High levels of overall burnout were reported among Hail University medical students. Students with a higher GPA, however, were found to be less prone to burnout. Keywords: Burnout Syndrome; Medical Students; Fatigue; Stress; Saudi Arabia.

Objectives: This study aimed to explore Saudi Arabian medical students’ perceptions of patient safety. Methods: A cross-sectional descriptive study was conducted in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, in September 2019. The Attitudes to Patient Safety Questionnaire (APSQ III) was used to explore undergraduate medical students’ attitudes towards and knowledge of PS. The main outcomes measured were the APSQ III’s nine domains. Data were analysed using Statistical Package for the Social Sciences and students’ attitudes were communicated as mean scores ± standard deviations. Results: A total of 301 participants were included in this study (response rate: 85.75%). Six domains reflected a positive attitude while three domains showed a neutral attitude. The domain of ‘team functioning’ had the highest mean score (5.8) followed by ‘working hours as a cause of error’ (5.6) and ‘error inevitability’ (5.4). There was a significant difference between gender in the domain ‘patient involvement in reducing error’ (P = 0.012) and ‘importance of patient safety (PS) in the curriculum’ (P = 0.001). In addition, the ‘importance of PS in the curriculum’ domain was significantly different across different age groups (P = 0.039). Conclusion: Medical students were highly interested in PS and recommended implementing a comprehensive undergraduate PS programme to fulfil their educational needs. Keywords: Undergraduate Medical Education; Patient Safety; Medical Errors; Attitude; Medical Students; Medical Ethics; Patient Care; Saudi Arabia.

Objectives: Brucellosis is a highly contagious zoonotic disease which can have serious health implications for affected humans and livestock. This study aimed to evaluate the clinical presentation, geographical distribution and risk factors of brucellosis cases admitted over a four-year period to two hospitals in Muscat, Oman. Methods: This observational study was conducted from January 2015 to December 2018 at the Sultan Qaboos University Hospital and Armed Forces Hospital in Muscat. All patients with probable or definitive diagnoses of brucellosis according to the diagnostic criteria of the World Health Organization were included. Relevant data were gathered from the patients’ medical records, including results from standard agglutination tests, Brucella enzyme-linked immunosorbent assays, bacterial blood or tissue/aspirate cultures and Brucella polymerase chain reaction tests. Results: A total of 64 patients were diagnosed with brucellosis over the study period. The median age was 31.5 years and 73.4% were male. The majority (95.2%) presented with fever, followed by weight loss (51%), transaminitis (48.4%), peripheral arthritis/arthralgia (15.9%) and back pain (spondylodiscitis/sacroiliitis; 23.4%). Overall, 75.5% reported having consumed raw dairy products, while only 25.9% gave a positive history of animal contact. Conclusion: Patients with brucellosis presented with a wide range of clinical features, the most predominant of which was fever. The majority of patients were residents of or had recently visited Salalah and had consumed raw dairy products. These findings highlight the need for healthcare practitioners to maintain a high index of suspicion for this diagnosis. Moreover, further regulatory measures are necessary to oversee the sale of raw/unpasteurised dairy products. Keywords: Brucellosis; Bacterial Infections; Zoonotic Bacterial Infections; Risk Factors; Epidemiology; Oman.

Objectives Many cancer patients experience social difficulties and feelings of isolation. This study aimed to evaluate patients’ and attendees’ attitudes towards cancer patients. Methods A cross-sectional study was conducted of patients and attendees attending Sultan Qaboos University Hospital (SQUH), Muscat, Oman, from December 2018 to March 2019. Results A total of 1,190 people participated (response rate: 91.5%). The majority (90.7%) did not express reluctance to help cancer patients. Most agreed that cancer patients were productive (76.2%) and are respected by the public (75.0%). However, many participants (63.1%) felt that cancer patients might face difficulties getting married. Multivariate analysis showed that participants who had a family history of cancer or had previously been a caregiver for cancer patients were more likely to believe that cancer patients could be productive (odds ratio [OR] = 1.92, 95% confidence interval [CI]: 1.31–2.82; P

Objectives Bone failure due to avascular necrosis (AVN) is a complex pathological phenomenon. Analysis of molecular changes in the bone matrix may help to shed light on the disease process and guide management. This study aimed to explore changes in bone quality and structural damage caused by sickle cell disease (SCD)-induced AVN using Raman spectroscopy. Methods A total of 10 necrotic femoral heads were obtained from seven SCD patients who underwent total hip replacements. The femoral heads were cut in half and scanned using Raman spectroscopy in correlation with preoperative magnetic resonance imaging to identify necrotic and healthy control areas. Subsequently, samples were examined to determine changes in bone mineralisation, crystallinity, carbonate content, collagen cross-linking and mineral and collagen fibril orientation. Results Significant changes were observed in bone mineral content, mineral-to-organic content and collagen fibril orientation in necrotic compared to control areas (P ≤0.050). Conclusion The necrotic samples displayed severe structural damage and loss of mineral and organic contents. Similar Raman signals have been reported in other metabolic bone diseases such as osteoporosis, thereby potentially supporting the use of medical treatment in AVN to promote bone quality.

Objectives This study aimed to report the clinicopathological features, management and long-term outcomes of patients with gastrointestinal stromal tumours (GISTs) in Oman. Methods This retrospective study was conducted on patients treated for GIST between January 2003 and December 2017 at three tertiary referral centres in Muscat, Oman. All patients with confirmed histopathological diagnoses of GIST and followed-up at the centres during this period were included. Relevant information was retrieved from hospital records until April 2019. Results A total of 44 patients were included in the study. The median age was 55.5 years and 56.8% were female. The most common primary site of disease was the stomach (63.6%) followed by the jejunum/ileum (18.2%). Two patients (4.5%) had c-Kit-negative, discovered on GIST-1-positive disease. A total of 24 patients (54.5%) presented with localised disease and eight (33.3%) were classified as being at high risk of relapse. Patients with metastatic disease received imatinib in a palliative setting, whereas those with completely resected disease in the intermediate and high-risk groups were treated with adjuvant imatinib. Of the six patients (13.6%) with progressive metastatic disease, of which four had mutations on exon 11 and one on exon 9, while one had wild-type disease. Overall, rates of progression-free survival and overall survival (OS) at 100 months were 77.4% and 80.4%, respectively. Rates of OS for patients with localised and metastatic disease were 89.9% and 80.2%, respectively. Conclusion The presenting features and outcomes of patients with GISTs in Oman were comparable to those reported in the regional and international literature.

Objectives This study aimed to generate baseline evidence regarding the effectiveness of atosiban in delaying delivery by ≥48 hours among pregnant women presenting with threatened preterm labour (TPL). The secondary objective was to assess the relationship between atosiban success and various perinatal factors and neonatal outcomes. Methods This retrospective study was conducted between June 2008 and May 2018 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all pregnant women who received atosiban between 24–34 gestational weeks for TPL during this period were reviewed. Results A total of 159 women were included in the study. Atosiban was successful in delaying delivery by ≥48 hours in 130 cases (81.8%). Approximately half of the women (50.9%) achieved uterine quiescence in

Objectives: Imperforate hymen (IH) is a common genital tract anomaly in women which usually presents after puberty. However, surgical treatment is often considered controversial in religious or conservative communities for sociocultural reasons. This study therefore aimed to assess the efficacy of a novel reconstructive technique involving the preservation of the annular hymen. Methods: This prospective interventional study was performed between July 2013 and October 2019 at the minimally invasive surgery unit of a tertiary university hospital in Egypt. A total of 36 women presenting with primary amenorrhoea and haematocolpus were diagnosed with postpubertal IH. A circular hymenotomy was performed on each patient using a 10 mm laparoscopy trocar tip and sleeve to form a new annular hymen under general anaesthesia while preserving the annular hymen. The primary outcome measure was the persistence of hymenal patency and integrity at follow-up. The secondary outcome measure included post-operative patient satisfaction and pain relief. Results: The reported technique was feasible in all cases without intraoperative complications. Patency of the reconstructed annular hymen was confirmed at follow-up in all cases; moreover, no intraoperative complications were reported. There was a significant post-operative improvement in pain scores (P

Objectives: Qualitative studies can improve understanding of patient safety culture (PSC), which has been relatively neglected by researchers in the Gulf Cooperation Council context. This study employed a qualitative approach to explore healthcare staff and patients’ perceptions of PSC and how it can be improved. Methods: This qualitative study was conducted in a public hospital in Kuwait. Individual face-to-face interviews were used to understand the experience of healthcare staff and patients concerning PSC. After obtaining the required ethical approvals, maximum variation sampling was used. Interviews were recorded and transcribed. The analysis was inductive and thematic. Results: A total of 51 participants were included in this study (35 healthcare professionals and 16 patients). Data analysis revealed four overarching themes relevant to the research question: (1) workload; (2) communication; (3) environmental constraints; and (4) incident reporting. These issues were interrelated in practice. Kuwaiti and non-Kuwaiti participants held different views, particularly about the response to errors and expatriate staff members’ clinical skills. Conclusion: This study revealed multiple factors related to workload, communication, healthcare environment and incident reporting, which hindered the promotion of positive PSC in the included department. The presence of numerous constraints suggests that multiple interventions which target both individual and organisational levels should be implemented. KEYWORDS Health Services Research; Patient Safety; Safety Culture; Kuwait.

Objectives: This study aimed to describe changes in self-efficacy (SE) and social support (SS) 12 months after the MOVEdiabetes trial, an intervention designed to increase physical activity (PA) among adults with type 2 diabetes mellitus in Oman. Methods: The original MOVEdiabetes trial was conducted between April 2016 and June 2017 in Muscat, Oman. The intervention group (IG) received personalised PA consultations, pedometers and monthly messages using a web-based application, while the comparison group received usual care. Self-reported SE and SS from family and friends were assessed using validated psychosocial scales. Results: Of the 232 original participants in the trial, a total of 174 completed the 12 months follow-up study period (response rate: 75%). However, based on intention-to-treat analysis with several imputation procedures for missing data at 3 and/or 12 months, there was a significant increase in SE scores in the IG (+10.3, 95% confidence interval [CI]: 7.1–13.5; P

Objectives: This study aimed to examine the attitudes and awareness of Iranian clinical nurses and midwives towards telenursing and telehealth also referred to as e-health. Methods: The cross-sectional study was conducted from February to August 2019 in Iran. Nurses and midwives were randomly recruited from hospitals affiliated with Mashhad University of Medical Sciences in Mashhad, Iran using a stratified cluster random sampling method. Data were collected using a reliable and valid Persian-language questionnaire consisting of 32 close-ended survey items to examine Internet/computer access, daily Internet use and awareness of and general attitude towards telehealth and telenursing; statistical analyses were performed. Results: A total of 523 nurses and midwives were included in this study (response rate: 94.4%). The mean age and duration of clinical practice were 33.36 ± 7.46 and 8.88 ± 6.73 years, respectively. The majority of participants recognised the definition of telenursing (66.7%) and telehealth (80.1%). A positive attitude towards telenursing and telehealth was reported by 73.0% of the participants. Clinical nurses and midwives with a master's degree were more aware of the definition of telehealth compared to those with undergraduate bachelor degrees (P = 0.03). Additionally, midwives significantly more frequently presented a positive attitude towards telehealth and telenursing compared to nurses (86.2% versus 71.2%; P = 0.01). Conclusion: The positive attitude of the current participants was an important factor in the promotion of telenursing and telehealth. The implementation of educational and infrastructure developmental programs can help speed up executional processes in these fields. KEYWORDS Telenursing; Telemedicine; Nurses; Midwives; Attitude; Awareness; Iran.

Objectives: The post-mortem interval (PMI) refers to the amount of time elapsed between death and discovery of the body. This study aimed to evaluate light microscopic cellular changes in the oral mucosa and identify the potential of this method for predicting PMI. Methods: This prospective study was conducted between July 2016 and January 2018 at the Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, India. A total of 150 post-mortem (including 75 gingival and 75 buccal mucosa samples) and 40 ante-mortem (including 20 gingival and 20 buccal mucosa samples) tissue samples were compared using haematoxylin and eosin, periodic acid-Schiff (PAS) and van Gieson stains. Microscopic changes in the epithelium and connective tissue were categorised according to PMI stage as early (20.5 hours since death). Results: Most epithelial cellular changes occurred early, except for arc-shaped nuclei and epithelial shredding which were intermediate and late changes, respectively. However, microscopic changes in the connective tissue were only observable at ≥12.5 hours. There was a progressive decrease in intensity in van Gieson stains and an increase in intensity in PAS stains as PMI increased. Several microscopic features were found to be significant predictors of PMI including epithelial homogenisation, cytoplasmic vacuolation, nuclear degeneration, arc-shaped nuclei, chromatin clumping, red blood cell clumping and lysis, melanin incontinency, myofibril degeneration, salivary gland acini degeneration and epithelial connective tissue separation (P

Objectives: Totally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers’ experiences. Methods: This retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded. Results: A total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3–1,872 days) for patients with complications and 550 days (range: 7–3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P

Objectives: This study aimed to describe patterns of prescribing co-amoxiclav to children aged ≤5 years at a polyclinic in Oman and to assess level of adherence to the antibiotic prescription guidelines outlined by the Omani Ministry of Health (MOH). Methods: This cross-sectional retrospective study was conducted between June and December 2017 at Ibri Polyclinic (IPC) in Ibri, Oman. A random sample of 399 children aged ≤5 years who were prescribed a suspension of co-amoxiclav over the four winter months of 2016 were included in the study. The children’s electronic medical records were reviewed to determine whether the prescription complied with MOH guidelines. Results: The majority of the children were 2–3 years old (52.4%). Overall, 73.9% of prescriptions were written by general practitioners, while 26.1% were written by specialists. Co-amoxiclav therapy was the first line of management in 90.5% of cases, regardless of category of prescriber. Culture tests were ordered in only 43 cases (10.8%), of which five (11.6%) were found to be sensitive to the prescribed co-amoxiclav. Conclusion: Unnecessary antibiotics were prescribed to many paediatric patients attending IPC. Strict enforcement of the MOH antibiotic guidelines is needed to reduce irrational or discretionary prescription of this type of antibiotic. Healthcare providers should receive additional training in evidence-based methods of prescribing antibiotics. KEYWORDS Antibiotics; Children; Co-Amoxiclav; Inappropriate Prescribing; Antibiotic Resistance; Oman.

Objectives: Falls and fall-related consequences are a major public health problem in the elderly. This study aimed to measure the prevalence of falls and fall-related risk factors among elderly individuals in Saudi Arabia. Methods: This cross-sectional study was conducted between January and October 2019 among 280 elderly patients aged >60 years old attending 10 randomly selected primary healthcare centres in Unaizah City, Qassim Province, Saudi Arabia. Data were collected using the validated 10-item Missouri Alliance for Home Care (MAHC-10) fall risk assessment tool. Results: A total of 269 participants were included in the study (response rate: 96.1%). The prevalence of falls over the preceding year was 31.6%. Females fell more frequently than males (34.5% versus 28.5%) and most falls occurred indoors (84.7%). Various risk factors were associated with fall risk including being aged >80 years (adjusted odds ratio [aOR]: 5.17, 95% confidence interval [CI]: 1.66–16.14), polypharmacy (aOR: 2.40, 95% CI: 1.01–5.71) and environmental factors (aOR: 2.79, 95% CI: 1.24–6.28). However, more educated participants had a lower risk of falling (aOR: 0.26, 95% CI: 0.09–0.77). There was also a significant association with the MAHC-10 fall risk score (P = 0.043). Conclusion: There was a high prevalence of falls among the elderly in Unaizah City. Various factors were associated with falls including advanced age, polypharmacy, age-related changes and environmental factors. As the majority of fall events occurred indoors, home safety improvements are recommended. Moreover, additional larger-scale research is necessary regarding fall-related risk factors and fall prevention initiatives among elderly individuals in Saudi Arabia. KEYWORDS Elderly; Falls; Geriatrics; Public Health; Prevalence; Risk Factors; Saudi Arabia.

Objectives Environmental hazards are part of the Earth’s natural cycle and are ongoing within human history. When vulnerable situations meet environmental hazards, disasters occur where human and natural costs could be enormous. This study aimed to explore the experiences of the victims of coastal erosion during the monsoon season. Methods Seven victims of catastrophic coastal erosion in the Kollam District of Kerala, India, were interviewed from December 2013 to February 2014. The study followed Edmond Husserl’s descriptive phenomenological method. Result These interviews constituted the primary data source. Three main themes with eleven subthemes emerged from these data. The main themes were impact, consequences and recovery. The subthemes were living in constant fear, escaping from the catastrophe; cataclysmic sea waves and their tumultuous behaviour, instant damage and destruction, the epoch of losses; agony and suffering; homelessness-helplessness-sleeplessness mixed with fear; government aid only in dreams; haunting memories; never-ending daily needs; first home and native land; and the desire to go back to the site of the disaster. Conclusion From the derived themes, a phenomenon associated with coastal erosion evolved. The phenomenon is termed “Catastrophic coastal erosion: A cycle of impact, consequences, and recovery.”

Objectives Stenotrophomonas maltophilia, a Gram-negative non-fermentative bacillus, has emerged as an important nosocomial pathogen in recent years. It is intrinsically resistant to many antibiotics and has the ability to acquire antibiotic resistance by multiple mechanisms. Treating Stenotrophomonas infections, therefore, is a serious challenge for physicians. This study aimed to investigate the antibiotic susceptibility patterns and risk factors contributing to S. maltophilia infections. Methods A retrospective cross-sectional study was conducted at Sohar Hospital in Sohar, Oman. The demographic, clinical and microbiological data of individuals from whom S. maltophilia was isolated between September 2016 and August 2019 were reviewed. Descriptive statistics were presented as frequencies and percentages. Results A total of 41 S. maltophilia isolates from clinical specimens of 41 patients were studied. Infection occurred predominantly in males (73%) and the majority of patients (88%) were either ≤5 years old or >60 years old. All inpatients had at least one comorbidity while 50% had more than one. All inpatients were exposed to various medical interventions such as intensive care (44%), mechanical ventilation (41%), haemodialysis (25%), Foley’s catheterisation (13%) and central venous lines (6%). Most patients (81%) were in hospital longer than two weeks. The susceptibility rates of S. maltophilia to minocycline (97%), trimethoprim-sulfamethoxazole (93%) and levofloxacin (92%) were high; the rate was lowest for ceftazidime (50%). Conclusion S. maltophilia was found to be an important nosocomial opportunistic pathogen. Prolonged hospital stay and exposure to various medical interventions were key factors contributing to the development of infection. Minocycline and ceftazidime were found to be the most and least susceptible drugs, respectively.

Objectives: There is a rising burden of breast cancer (BC) in the Eastern Mediterranean Region (EMR), and its sociopsychological impact is a quickly growing health concern in this region. Because understanding cancer patients’ perceptions of life is integral to their treatment, they are also a concern for healthcare providers. This qualitative study, therefore, explored changes in Omani women’s perceptions of life after a BC diagnosis. Methods: Semi-structured interviews were conducted individually with 21 Omani women undergoing treatment for BC at the Oncology Ward of Muscat’s Royal Hospital from March to May 2017. The collected data were subjected to qualitative content analysis. Results: After their cancer diagnosis, the women appeared to pass through three main stages in their coping processes. First, they passed through a stage of severe psychosocial distress and diminishment in personal identity. Next, they evolved strategies for coping based on cultural, religious and family resources. Finally, the women experienced acceptance and submission to the reality of the cancer as God’s will with changes in attitudes and perceptions of the meaning of life. Conclusion: A BC diagnosis impacts Omani women severely, affecting their lives dramatically. They adopt coping strategies based on cultural, religious and spiritual beliefs. Healthcare providers need to acknowledge and facilitate women’s spiritual and cultural coping strategies as an integral part of their treatment which holds potential to improve their prognosis. Such strategies should be individualised to suit each woman’s experiences, perceptions and needs. Keywords: Breast Neoplasm; Culture; Perceptions; Life; Women; Oman.

Objectives: Atypical squamous cells of undetermined significance (ASC-US) represent a diagnostic challenge during cervical cytology. This study aimed to review and identify high-risk human papillomavirus (HR-HPV) genotypes among previously diagnosed ASC-US cases in Kuwait. Methods: This retrospective study analysed 180 cases diagnosed as ASC-US between June 2017 and May 2018 at the Mubarak Al-Kabeer Hospital, Kuwait. Cervical specimens were assayed to determine the presence of HR-HPV DNA; subsequently, positive cases underwent genotyping and were categorised into three groups (HPV 16, HPV 18/45 and other HR-HPV types). Results: In total, ASC-US was confirmed in only 105 cases (58.3%), with the remaining cases reclassified as negative for intraepithelial lesions or malignancy (NILM; 32.2%) and epithelial cell abnormalities (ECA; 9.4%). Of these, HRHPV DNA was present in 20 ASC-US (19%), one NILM (1.7%) and six ECA (35.3%) cases. There were 62 Kuwaiti and 43 non-Kuwaiti women with confirmed ASC-US; of these, three (4.8%), six (9.7%) and four (6.5%) Kuwaitis and one (2.3%), one (2.3%) and five (11.6%) non-Kuwaitis had HPV 16, both HPV 16 and 18/45 and other HRHPV genotypes, respectively. Of those with HR-HPV DNA, the NILM case had the HPV 18/45 genotype, while the six ECA cases had the HPV 16 (n = 1), both HPV 16 and 18/45 (n = 1) and other HR-HPV (n = 4) genotypes. Conclusion: Overall, HR-HPV DNA was present in 19% of ASC-US cases compared to 1.7% of NILM cases initially misdiagnosed as ASC-US. Re-review of cervical cytology diagnoses may reduce unnecessary costs associated with HR-HPV genotyping. Keywords: Cervical Smears; Atypical Squamous Cells of Undetermined Significance; Human Papilloma Virus; Cytological Techniques; Papanicolaou Test; Kuwait.

Objectives: This study aimed to assess and explore factors affecting diabetes self-management (DSM) among Omani adults with type one diabetes mellitus (T1DM). Methods: This cross-sectional study was conducted from May to November 2018. Convenience sampling was used to recruit participants from three referral hospitals in Oman. Data were collected using the Diabetes Self-Management Questionnaire, Empowerment Scale (short form), Medical Outcome Study Social Support Scale, Diabetes Knowledge Test and glycosylated haemoglobin test results. Linear multiple regression analysis was used to explore possible predictors of DSM. Results: A total of 210 people participated in the study (response rate: 87.5%). The majority of participants were female (70.5%) with a mean age of 26.82 ± 8.25 years. The mean score for DSM was 6.8 ± 1.4, which represents 68% of the total maximum score. More than one-third (36.2%) of the participants had poor glycaemic control. The predictors of high levels of DSM were being employed (P = 0.049), earning a low monthly income of less than 300 Omani rials (P = 0.014), having other chronic diseases (P = 0.029), a high diabetes self-efficacy (DSE; P = 0.003) and high social support (SS; P = 0.006). Conclusion: According to the findings of this study, Omanis with T1DM have suboptimal DSM levels. Factors such as diabetes knowledge, DSE and SS are modifiable factors that can be targeted by interventions from different healthcare professionals to enhance DSM. Keywords: Diabetes Mellitus; Type 1 Diabetes Mellitus; Self-Management; Adult; Oman.

Objectives Unplanned return to the operating theatre refers to an unplanned reoperation following a primary surgical procedure and can result in serious complications. The rate of unplanned reoperations is often used as a measure of in-hospital quality monitoring and improvement. This study aimed to review the prevalence rate and features of unplanned gynaecological reoperations at a major general hospital in Jordan. Methods This retrospective study took place between January 2011 and January 2018 at The Specialty Hospital in Amman, Jordan. The medical records of all women who underwent unplanned reoperations following a primary gynaecological procedure during this period were reviewed. Results A total of 4,895 primary gynaecological procedures were performed during the study period, of which 4,175 (85.3%) were elective and 720 (14.7%) were emergency operations. There were 15 unplanned reoperations (0.3%); of these, 14 (93.3%) followed elective procedures and one (6.7%) followed an emergency surgery. Most reoperations were performed following hysterectomies (53.3%). Bleeding was the predominant reason for reoperation (93.3%), with the source of the bleeding successfully identified in 71.3% of cases. In terms of outcome, none of the cases required a subsequent reoperation and there were no mortalities. Conclusion The rate of unplanned reoperation at a hospital in Jordan was 0.3%. Unplanned reoperations occurred primarily as a result of bleeding following hysterectomies. Development of care pathways may reduce surgical complications and rates of unplanned reoperation.

Objectives: Self-efficacy is an important factor in determining the ability of students to execute tasks or skills needed in the implementation of interprofessional learning (IPL). This study aimed to identify levels of self-efficacy with regards to IPL skills among undergraduate healthcare students and to investigate differences according to gender, programme of study and year of study. Methods: This descriptive cross-sectional study was conducted between January and March 2018 at the International Islamic University Malaysia, Kuantan, Malaysia. The Self-Efficacy for Interprofessional Experiential Learning scale was used to evaluate the self-efficacy of 336 students from five faculties including nursing, medicine, dentistry, pharmacy and allied health sciences. Results: Significant differences in self-efficacy scores for the interprofessional interaction subscale were identified according to programme of study, with pharmacy students scoring significantly lower than allied health students (mean score: 54.1 ± 10.4 versus 57.4 ± 10.1; P = 0.014). In addition, there was a significant difference in self-efficacy scores for the interprofessional interaction subscale according to year of study, with first-year students scoring significantly lower compared to fifth-year students (mean score: 52.8 ± 10.4 versus 59.9 ± 11.9; P = 0.018). No statistically significant differences in self-efficacy scores were identified with regards to gender or for the interprofessional team evaluation and feedback subscale. Conclusion: These findings may contribute to the effective implementation of IPL education in healthcare faculties. Acknowledging the influence of self-efficacy on the execution of IPL skills is crucial to ensure healthcare students are able to adequately prepare for future interprofessional collaboration in real clinical settings. Keywords: Self Efficacy; Intersectoral Collaboration; Interdisciplinary Research; Professional Competence; Learning; Undergraduate Medical Education; Malaysia.

Objectives: Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. A characteristic feature of the spleen is the presence of splenic notches at the superior border; however, such notches rarely extend deep enough to be considered fissures or to separate the spleen into multiple lobes. To date, there are very few cadaveric reports of splenic fissures. This study aimed to examine the anatomy and morphological structure of spleens collected from cadavers in order to identify the prevalence and clinical significance of splenic notches, fissures and lobation. Methods: This study was conducted at the Department of Anatomy, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India. A total of 50 spleens were collected from cadavers over a period of seven years from 2012–2019 and examined to determine the presence of splenic notches or fissures. Results: Of the 50 spleens, 40% had notches at the superior border, 10% had notches at the inferior border and 50% had no notches at either border. Fissures were present in five spleens (10%); of these, three showed incomplete fissures and the remaining two had complete fissures that divided the spleen into two lobes. Conclusion: The findings of this study provide valuable information regarding the anatomy and prevalence of splenic fissures and bilobed spleens. A bilobed spleen is a rare congenital malformation which should be considered distinct from other known splenic anomalies. The presence of splenic fissures in bilobed spleens can serve as a guide for surgeons during conservatory splenectomy procedures. Keywords: Anatomic Variation; Spleen; Anatomy and Histology; Abnormalities; Congenital Abnormalities; Splenectomy; India.

Objectives This study aimed to review the experience with percutaneous closure of ventricular septal defects (VSDs) at the National Heart Center (NHC) in Muscat, Oman. Methods This retrospective study was conducted from November 2008 to December 2017. Patients’ electronic medical records were reviewed to identify their clinical, imaging and interventional data before and after the procedure and on the last follow-up. Results A total of 116 patients, the majority of which were female (58%), underwent 118 percutaneous procedures for VSD closure at a median age of 3.54 years (range: 0.25–33 years) and a median weight of 12 kg (range: 3.5–78 kg). The mean diameter of the VSDs as determined by transoesophageal echocardiogram was 5.6 ± 1.9 mm (n = 105). The commonest type of VSD was perimembranous (n = 75, 63.5%). Devices were successfully placed during 111 (94.1%) procedures in 109 (94.0%) patients, with the commonest device being a Amplatzer™ duct occluder I (St. Jude Medical, Little Canada, Minnesota, USA; n = 39, 35.1%). There was no mortality. Early major cardiac complications occurred in six patients (5.5%) with device embolisation being the commonest (n = 4, 3.7%). The median follow-up period was 19 months (range: 1–84 months) in 89 (81.7%) of the patients. One patient (0.9%) required a permanent pacemaker for a complete heart block. Conclusion This study has demonstrated a good rate of VSD closure with low morbidity and no mortality using the percutaneous approach with different devices. Long-term follow-up is needed to specifically evaluate the function of adjacent structures and the long-term effects on conduction systems.

Objectives Hepatocellular carcinoma (HCC) is the most common type of primary liver tumour worldwide and is increasing in incidence. This study aimed to describe the clinical characteristics of HCC among Omani patients, along with its major risk factors, outcomes and the role of surveillance. Methods This retrospective case-series study was conducted between January 2008 and December 2015 at the three main tertiary care hospitals in Oman. All adult Omani patients diagnosed with HCC and visited these hospitals during the study period were included. Relevant data were collected from the patients’ electronic medical records. Results A total of 284 HCC patients were included in the analysis. The mean age was 61.02 ± 11.41 years and 67.6% were male. The majority had liver cirrhosis (79.9%), with the most common aetiologies being chronic hepatitis C (46.5%) and B (43.2%). Only 13.7% of cases were detected by the HCC surveillance programme. Approximately half of the patients (48.5%) had a single liver lesion and 31.9% had a liver tumour of >5 cm in size. Approximately half (49.2%) had alpha-fetoprotein levels of ≥200 ng/mL. The majority (72.5%) were diagnosed using multiphase computed tomography alone. Less than half of the patients (48.9%) were offered one or more HCC treatment modalities. Conclusion The majority of Omani HCC patients were male and had cirrhosis due to viral hepatitis. In addition, few patients were identified by the national surveillance programme and presented with advanced disease precluding therapeutic or even palliative treatment.

Objectives This study aimed to compare the effectiveness of the bacillus Calmette-Guérin (BCG) vaccine with topical salicylic acid (SA) in the treatment of viral warts. Methods This non-randomised controlled trial was conducted at the Al-Sader Teaching Hospital, Basrah, Iraq, from January 2016 to April 2017. A total of 201 patients with viral warts were injected with an intradermal purified protein derivative. Subsequently, those with negative tuberculin test results received an intradermal BCG vaccination, while those with positive results underwent conventional treatment with topical SA. Patients were assessed for any signs of improvement at one, two and three months. Results Overall, 190 patients completed the trial; of these, 133 (70%) received the BCG vaccine and 57 (30%) were treated with topical SA. Complete response to treatment was observed in 9.8% and 5.3% of patients in the BCG and SA groups, respectively (P

Objectives Waterpipe or hookah smoking has grown considerably in popularity over the past two decades; however, consumers often have misconceptions regarding this practice. This study aimed to determine common beliefs related to waterpipe smoking among Turkmen in Iran. Methods This qualitative study was conducted between February and June 2018 in Golestan Province, Iran, utilising data from a previously published study. A total of 26 male Turkmen waterpipe smokers of different ages, occupations and education levels underwent in-depth semi-structured interviews. A content analysis of beliefs regarding waterpipe smoking was performed. Results Five categories of beliefs were extracted during the content analysis, including beliefs related to addiction, health-related beliefs, preferential beliefs for waterpipe versus cigarette smoking, beliefs related to the social function of waterpipe smoking and beliefs attributed to waterpipe smoking. Several misconceptions were identified, including the idea that waterpipe smoking was not addictive, prevented the use of other more dangerous drugs (i.e. cannabis and opium) and was not as harmful as cigarette smoking. Conclusion The results of this study indicate that Turkmen in Iran hold several misconceptions regarding the use of waterpipe smoking. Educational programmes are essential to correct such misconceptions and to control the prevalence of this habit in Iran.

Objectives: After completing the pre-clinical phase of a Doctor of Medicine (MD) curriculum, undergraduate medical students may choose to add a Bachelor of Science (BSc) degree in health sciences to their MD degree. Limited data exists on the motives behind students’ decisions to undertake such intercalated degrees. Hence, this study aimed to identify the factors that influence students in making this choice. Methods: Undergraduate students who chose the research-based academic track of the intercalated phase of the BSc programme at the College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, between 2014–2018 were enrolled. A standardised and validated self-explanatory questionnaire examining motivations to join the intercalated phase was administered to all students in the first week of enrolment. Results: Over a five-year period, out of 557 eligible students, 18 (3%) were enrolled in the intercalated phase and all completed the questionnaire. The mean age was 22 ± 1.5 years and the majority (83%) were female. Out of the 18 students, 10 (55%) had taken the university’s foundation programme. A total of 45% of students chose to intercalate out of their own interest, regardless of career ambitions. The main reasons to intercalate were an opportunity to enhance research experience, alignment with long-term career goals and a chance to publish in indexed journals. Conclusion: Despite the benefits of obtaining an additional degree, a relatively small proportion of MD students were attracted to the intercalated phase. A better presentation of the BSc degree is needed to help students make a more informed decision. Keywords: Medical Education; Undergraduate Medical Education; Career Choice; Curriculum; Oman.

Objectives This study aimed to assess knowledge of breast cancer (BC) risk factors, warning signs and symptoms and breast self-examination (BSE) practice among Omani female teachers in Al-Dhahira Governorate. Methods A cross-sectional sample of female teachers aged 20–50 years was collected from January to December 2018 from three wilayats (provinces) in Al-Dhahira—Ibri, Dhank and Yunqal. A questionnaire that included the Breast Cancer Awareness Scale and demographic characteristics was administered. Data were analysed using descriptive statistics, regression analysis and Pearson’s Chi-square test. Results A total of 478 female teachers were included in the study (response rate: 72.4%). The majority of participants (60.5%) had good overall knowledge about BC while 19.9% of participants had excellent overall knowledge. Only 9% of participants demonstrating excellent knowledge of BC risk factors. More than half of the participants (56.1%) reported excellent knowledge in screening methods. Unfortunately, only 57% of the female teachers indicated practising BSE. Knowledge of BC symptoms was closely divided between excellent and good levels (45.8 and 42.5%, respectively). BSE practice was significantly (P

Objectives The increasing prevalence of herbal medicine use is a global public health concern. Critically, many women continue to use herbal medicines during pregnancy despite potential maternofetal risks. The current study aimed to determine the prevalence of and factors associated with herbal medicine use during pregnancy in Saudi Arabia. Methods This cross-sectional study was conducted between February and May 2017. An Arabic-language 33-item survey assessing herbal medicine use was designed and distributed to 879 random women attending outpatient clinics at governmental and private hospitals in Hail, Saudi Arabia. Only women who were pregnant or had been pregnant in the previous 10 years were included. Results The mean age of the participants was 29.5 years, with 49% under 30 years old. Overall, 33% of the respondents claimed to have used herbal medicines during pregnancy. The most common reasons for doing so were to improve lactation (73%), improve the course of the pregnancy (56%) and facilitate labour (49%). Women who worked full-time and those with high school diplomas or above were significantly more likely to use herbal medicines during pregnancy (P

Objectives: Faculty members are the most important resource in any institution of higher education as medical education has been, and continues to be, a priority for medical colleges in Saudi Arabia. This study aimed to assess faculty members’ perceptions of faculty development programmes (FDPs) in supporting important goals in medical education. In addition, this study aimed to assess faculty members’ perceived needs. Methods: This crosssectional study was conducted between August 2016 and August 2017 and involved participants from six universities in Saudi Arabia’s Western Province. The survey consisted of 31 items designed to assess FDP effectiveness and 49 items designed to assess needs in FDPs. Results: A total of 210 faculty members participated in the study (response rate = 52.5%) and identified 49 needs. Faculty members perceived personal improvement in delivering medical education and the provision of greater educational involvement as the most effective considerations in an FDP. The respondents considered 13 needs to be of utmost importance; the remaining were considered important. Conclusion: This study assessed and identified faculty needs and important skills to consider when establishing an FDP. Furthermore, it provided information addressing the needs of, or gaps between, current and desired conditions in medical education in Saudi Arabia. The study also identified the most important elements (i.e. personal improvement) of faculty-perceived effectiveness for a successful FDP in medical education. Keywords: Faculty; Program Development; Needs Assessment; Perception; Medical Education; Saudi Arabia.

Objectives This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. Methods This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 μg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. Results There was a significant reduction in mean heart rate at 3–5 minutes in both treatment groups compared to the control group (P

Objectives: The College of Medicine at Gulf Medical University (GMU), Ajman, United Arab Emirates, was subjected to a curricular reform, which shifted the institution from a traditional curriculum to a hybrid, studentcentred, integrated curriculum. There are no previous studies analysing the consequences of such a curricular modification on the educational environment (EE). Therefore, this study aimed to analyse the EE of a pioneer cohort of the innovative curriculum over their five-year course of study. Methods: This prospective longitudinal study was conducted between September 2009 and September 2013 at the College of Medicine. The Dundee Ready Education Environment Measure questionnaire was completed by a pioneer cohort of students at the start of each academic session for five consecutive years. The mean overall, subscale and individual statement scores were evaluated using the Kruskal-Wallis and Wilcoxon-rank sum tests. Results: A total of 178 responses were collected (response rate: 90.4%). The mean overall score throughout the five years of study was 130/200. A significant difference in the scores ( P